The stated goal of the Affordable Care Act (ACA), also known as “Obamacare,” is to make healthcare affordable for the general public. With healthcare spending in the U.S in 2013 totaling $3 billion dollars, and projected to rise 6% annually, one can understand that healthcare costs are quite burdensome for individuals, families, and businesses.

While the ACA as a whole has received much media attention, one important aspect of the act has not. This portion of the law involves the enhancement of the False Claims Act (FCA) by which qui tam or whistleblower lawsuits are brought by individuals. These lawsuits bring fraudulent billing and other false claims in the healthcare industry to light. The FCA enables the government, with the help of private whistleblowers, to recover significant dollars that were fraudulently claimed as healthcare expenses. In 2013, some $2.6 billion was recovered from healthcare fraud cases.

While qui tam or whistleblower cases may be risky, whistleblowers do have an incentive to come forward with information regarding false claims and fraud against the government. Whistleblowers can receive 15-30% of what the government is able to recover as a result of a qui tam or whistleblower lawsuit. In 2013, FCA whistleblowers received $345 in incentive awards. This financial incentive is necessary to encourage private individuals to come forward, often at great personal sacrifice and expense, with information that helps taxpayers recoup billions of dollars lost annually to healthcare fraud, and to help ensure that fraud is minimized in these cases.

For more information regarding false claims and other fraudulent conduct the FCA prohibits healthcare facilities, providers, and drug manufacturers from engaging in, take a look at the The Affordable Care Act and Qui Tam Whistleblower Claims. This concise article, co-authored by Atlanta attorney Jay Brownstein, is quite informative on the topic.

The Primer on Whistleblowing in Healthcare, co-authored by Atlanta attorney Jay Brownstein, is an excellent resource regarding healthcare fraud. Healthcare fraud, including false and deceptive billing practices, costs taxpayers upwards of $80 billion each year. Healthcare fraud comes in many shapes and varieties, including fraudulent billing, kickback schemes, and other illegal practices. With Medicare and Medicaid paying the majority of these expenses, taxpayers ultimately pay the bill for healthcare fraud.

In their article, Jay Brownstein and Kevin Little educate the public on what whistleblowing is, how it relates to the area of healthcare fraud, and what to do should healthcare fraud be suspected. They point out that healthcare providers and employees need to be aware of their rights, as there are many state and federal laws in place to protect them in whistleblowing instances. Additionally, an outline of what to look for in billing fraud, illegal referral fees or kickback schemes, and drug manufacturer or medical device fraud is included. The article also identifies steps to take to help protect oneself before reporting fraud or wrongdoing in the healthcare industry.

Each year, many courageous private citizens bring qui taim, or whistleblower lawsuits, to help the government recover billions of dollars in fraudulent healthcare claims. The Primer on Whistleblowing in Healthcare is a quick, informative read for those interested in the topic.

Have you ever looked at a hospital bill with utter disbelief? You are not alone. Medical bills are the number one cause of personal bankruptcy filings in the United States. The cost of hospital care can be extraordinary, especially in light of the fact that many hospitals are operated as non-profits. Exacerbating the problem is the fact that most often patients in need of urgent care have no ability or opportunity to comparison shop. Hospitals essentially operate free from market constraints.

It has recently come to light that due to the manner in which hospitals establish pricing for services, the retail or gross charges to patients (before insurance payments or discounts) are entirely arbitrary. Last year, author Steven Brill outlined some of the exorbitant costs of medical care in an important Time magazine special report titled “Bitter Pill”. Using the specific examples and powerful personal narratives of ordinary people who have suffered from unreasonably high medical expenses, Brill has exposed previously hidden truths about our healthcare system that help unravel the mystery of spiraling healthcare costs. Hopefully, Brill’s research and undeniable conclusions will help create a level playing field for the general public and policymakers in understanding how to combat and perhaps one day solve the problem.

One element of Brill’s research that seemed the most surprising was the existence and function of a hospital “chargemaster.” Before “Bitter Pill,” most of us had likely never heard of a chargemaster. As the name hints, a chargemaster is responsible for assigning the retail charges for all medical procedures, services, medications and supplies at a hospital. Using supporting visual references such as hospital bills and receipts, Mr. Brill does a superb job of documenting how charges can vary depending on a patient’s coverage. One example he uses is that of a chest X-ray in which a patient was charged $333.00. The same X-ray is covered for a Medicare patient at a rate of $23.83. Another example is a case in which a patient is charged $1.50 for one acetaminophen tablet (acetaminophen is the main ingredient found in the brand name painkiller Tylenol). The price for one tablet is in the same ballpark as what an entire bottle of the generic drug may be purchased for.

Bitter Pill is a great stepping stone into the discussion of fraudulent billing. More information can be found regarding the matter of fraudulent billing of Medicaid in the Primer on Whistleblowing in Healthcare , an article co-authored by Brownstein & Nguyen attorney Jay Brownstein. An experienced attorney who handles complex litigation matters, Jay Brownstein has consulted and represented clients in whistleblower cases. If you suspect that you have been overbilled or “up-coded” as a result of a hospital or nursing home stay, contact our trusted Atlanta attorneys for a free consultation regarding healthcare whistleblowing.